FAQ
 

FAQ


What is the AAPP?

SimpleCare is a program of the American Association of Patients and Providers (AAPP), a non-profit organization.  The AAPP was founded by physicians to form a unique association of patients and licensed health care providers that work together to implement patient-focused solutions for our ailing health care system.  By joining SimpleCare, you are also a member of the AAPP.


For Patients:

How do I find participating providers?
Our website includes a continually updated directory of SimpleCare providers, searchable by location or specialty.  SimpleCare is rapidly expanding nationwide, so be sure to check back for additional providers.

What if my doctor is not on the list or there are no providers in my area?
No problem.  We want you to have the freedom to visit the providers you chose instead of restricting you to a list.  We encourage you to let your health care providers know about SimpleCare.  Simply direct them to this website for more information.

What if I move or need medical care while traveling?
You can visit SimpleCare providers anywhere in the United Sates by showing your physical or digital membership card.  If you move, just visit a local SimpleCare provider and/or find new providers and ask them to join.  

What if I need a medical specialist or alternative care?
With SimpleCare, there is no limit on the type or number of licensed health care providers you can choose or ask to join, including both traditional medical doctors and alternative practitioners (physicians, hospitals, cardiologist, oncologists, pharmacists, labs, naturopaths, chiropractors, licensed therapists, etc.).   We realize your medical needs may change, so you can change providers or request that other providers join anytime.

Do pharmacies offer SimpleCare prices?
Pharmacies are joining SimpleCare and offering their "best price."  You can ask your local pharmacist(s) to join just like any other licensed health care provider.

Do you credential or monitor your providers?
SimpleCare providers are licensed and governed by their appropriate professional organization(s).  Since other agencies review and enforce provider credentials, it is not necessary for us to perform these functions.  But most importantly, patients have the freedom to choose the quality health care providers that are appropriate for them.

How much will SimpleCare save me?
Many SimpleCare providers have reduced their standard fees 30% to 50% for SimpleCare patients.  Each SimpleCare provider determines their best price, therefore savings will vary by provider.  You could save more than the annual AAPP SimpleCare membership fee ($29 per individual or $39 per family) in just one trip to your SimpleCare provider.

How are membership fees used?
The Non-Profit American Association of Patients and Providers operates on a limited budget, charging an annual fee of only $29 for individuals and $39 for a family.  This minimal amount is used for normal office and administrative expenses, as well as marketing and provider network expansion, member/customer service and assisting patients, providers and other organizations with inquiries.  Your AAPP-SimpleCare membership fee also helps the AAPP offer other innovative programs for our ailing health care system and the 50 million uninsured in our country.

Will SimpleCare reimburse my doctor?
No.  SimpleCare is not an insurance company.  Participating doctors, labs, etc. voluntarily lower their fees for SimpleCare patients who pay in full at the time of service.  Health care providers who do not participate in SimpleCare will not have the SimpleCare system set up in their office and will not offer SimpleCare prices. 

Is SimpleCare ACA Compliant?
No.  SimpleCare is not Insurance or a Discount Medical Plan.  You must still be enrolled in an ACA compliant program to meet IRS requirements.


For Providers:

Is it legal?
We have worked with our lawyer to ensure that SimpleCare fully complies with laws governing healthcare and insurance, in regard to how we operate as a non-insurance or government entity. SimpleCare is designed for those without insurance and those with high-deductible major medical insurance or a health share organization.

We have been assured by Medicare that patients who are not receiving benefits from the Medicare program do not fall under Medicare guidelines.  See the Medicare information section below.

It is important to remember that SimpleCare is NOT designed to be a "discount" program.  It is designed to be a program that allows doctors to charge a fair and reasonable price for their service and be reimbursed in full at the time of service, without incurring the high expense of billing and coding associated with most insurance and third-party contracts. Medicare patients may still benefit from SimpleCare if a service is not covered by Medicare (cosmetic surgery, preventive services etc.) 

Patients also have the right to specifically tell you to not bill Medicare for confidentiality reasons, and SimpleCare may benefit them in this situation also.  See below for more details about Medicare. This information does not substitute for legal advice.  If you are still concerned about the legality of SimpleCare, please consult your attorney.

What is my "best price," anyway?
You establish the SimpleCare price that is fair for you and your patients. By eliminating administrative costs associated with activities such as billing, producing insurance claim forms, coding diagnoses and procedures, referrals, authorizations, payment delays, EOB reviews, claim denials, re-submissions, collection risks, and other "managed care costs, you provide patients a fair price for services without the administrative hassles and bureaucracy.  Many physicians reduce their standard billed charges 30% to 50% for SimpleCare patients and benefit financially, but your SimpleCare price is your decision.  Additional information is provided in your membership kit on how to reduce your paperwork and unnecessary administrative costs, and guidelines for establishing a fair profitable price.

How does SimpleCare help me attract new patients?
Membership to AAPP/SimpleCare includes a listing in our searchable online directory, including a provider profile page with pertinent information about your practice.  Patients can find participating providers by searching the directory or calling the membership center. 

SimpleCare is increasingly gaining attention in the news.  Patients will identify your practice as belonging to SimpleCare and they will know they can receive your "best price" when paying in full at the time of service. 

To strengthen this association, you may wish to include SimpleCare in your advertisements and send a press release to the media in your area, specifically mentioning your practice in conjunction with SimpleCare.  Contacting other SimpleCare providers in your area can also help to generate new business.

The AAPP assists SimpleCare patients in finding participating providers in their area, but it is important to note that the AAPP is NOT a referral agency and should not be relied upon as such.  SimpleCare's primary function is to make your clinic more cost-effective and efficient when dealing with self-pay patients.

How does SimpleCare "code" services?
We created a simple coding system--5 codes rather than the approximately 7500 codes found in the CPT book that are updated every year.  SimpleCare is a totally different service and does not involve billing, therefore you should not use the CPT or insurance billing coding scheme for SimpleCare patients. With SimpleCare, you are not performing all the billing and administrative services included in your CPT/insurance bills. 

To distinguish SimpleCare from other services, we use Brief, Short, Medium, Long, and Comprehensive to describe most visits, or you can choose common-sense descriptive words for the types of services you offer.  This simple approach saves you time, avoids confusion, and reduces your legal exposure for accidentally miscoding a service.

Some doctors erroneously think the CPT manual is a required legal document and has to be used for all patients.  The CPT code book is a joint venture between the AMA and HCFA that has been adopted by some insurance companies but is not required for other purposes. The AMA has been under legal attack for their monopoly on CPT codes.  In a recent article in AMA News, Ted Lewers, MD, writes, "Nothing... prevents the federal government or any private insurer from choosing another code set over CPT.  It is possible for a new coding system to be introduced by groups far removed from hands-on patient care."

I would like to let patients enroll at my clinic.  But what about the costs I incur by doing so?
The AAPP is a grassroots association that believes in the spirit of patients, physicians and allied health care providers working together to improve the current health care system.  We are confident that the simplicity of the program speaks for itself.

We encourage you and your staff to let your patients/clients know about SimpleCare verbally. Signing up using our website takes only a few minutes, which can be done right in your office.  You can also copy the original forms included in your membership packet for your patients/clients to complete and mail in to our membership service center, along with a check or credit card information, for manual entry into our database.  Mailed in enrollments can take up to 2 weeks to be processed.  Online enrollment is immediate and secure.

What about Medicare?

Physicians and health care providers are often concerned about compliance with Medicare.  Based on our research and conversation with HCFA, providers may charge SimpleCare prices for services or patients/clients not covered by Medicare.  Of course, Medicare rules and regulations do apply to Medicare providers when providing Medicare covered services to Medicare patients.  The following provides more specific information:

Medicare Providers
Services or patients not covered by Medicare are not subject to Medicare rules and regulations (based on information obtained from the Medicare office at 701-277-6782).

Can non-Medicare patients be charged my SimpleCare price?  YES

Can Medicare patients be charged my SimpleCare price if the service is not covered by Medicare (Example: Annual Physical Exam)?  
YES, but the Medicare patient should be asked to sign a private contract or waiver that acknowledges that the physician or practitioner is not limited in the amount that he or she may charge the beneficiary for the items and services furnished?  In a private contract, the Medicare beneficiary agrees to give up Medicare payment for services furnished by the physician or practitioner and to pay the physician or practitioner without regard to any limits that would otherwise apply to what the physician or practitioner could charge.?  

Can Medicare Part A patients be charged my SimpleCare price for Part B physician services if they do not purchase Medicare Part B?  YES

Non-Medicare Providers
Providers who opt out of Medicare may charge a different price for Medicare covered services.

Can I charge Medicare patients my SimpleCare price for services covered by Medicare? 
YES, but the Medicare patient should be asked to sign a private contract that acknowledges that the physician or practitioner has opted out of Medicare and is not limited in the amount that he or she may charge the beneficiary for the items and services furnished?  In a private contract, the Medicare beneficiary agrees to give up Medicare payment for services furnished by the physician or practitioner and to pay the physician or practitioner without regard to any limits that would otherwise apply to what the physician or practitioner could charge.?

Can I charge Medicare patients my SimpleCare price for services not covered by Medicare?  
YES, Since Medicare rules and regulations do not apply to items or services not covered by Medicare, a private contract is not needed to furnish such items or services to Medicare beneficiaries? (such as routine physical exams and cosmetic surgery).  Similarly, where a beneficiary, who is enrolled in a Medicare risk-based managed care plan, goes out of plan to acquire a service and the plan does not cover it, the enrollee is liable for the full charge for the service and the physician or practitioner does not need to sign a private contract to collect payment for the non-covered service.? 

The above information is based on our research and information provided by HCFA, it is for educational purposes only and is not intended to substitute for appropriate regulatory or legal advice.  For additional information, we suggest you contact HCFA directly or your legal counsel.  You may also send Medicare questions to Don Self, a Medical reimbursement consultant, at donself@donself.com


For Employers:

Why should employers offer SimpleCare?
You’ll be a hero if you do!  SimpleCare can be added as a benefit to help employees afford out-of-pocket medical expenses such as medical services, alternative care, or providers not covered by insurance.  Most people never satisfy today’s high deductibles, unless they have a catastrophic health event, so simple office visits are charged at the over inflated insurance rate. 

Patients can use SimpleCare for small items and only submit claims for larger items that they wish to apply toward their deductible. 

SimpleCare can be offered as an add-on to your traditional group health insurance or combined with a high deductible insurance policy with an attached HSA or Health Share Organization Membership.

Can I offer this to employees in all states?
SimpleCare can be implemented in all your employee locations nationwide with the exception of Nevada.

Contact our membership services team to discuss a group rate on annual membership fees.


For Insurance Agents:

Why should insurance companies offer SimpleCare?
SimpleCare can complement your high deductible policies by allowing your clients to save money on their routine health care.  Patients can use SimpleCare for small items and only submit claims for larger items that they wish to apply toward their deductible.  This also saves money for the insurance company by reducing administrative costs.

 


I still have questions.  Can you help?
Of course!  Contact us and we'll be happy to answer any other questions you may have.